Payment Integrity | Approach

**Different vendor models.** Very different visibility.

Traditional payment integrity vendors hand back savings summaries and little else. See exactly why claims are flagged, iterate rules in hours instead of weeks, and gain full operational control over your PI program.
Read the case study: How Precision AI Unlocked $1M+ in Inpatient DRG Savings
Explore Payment Integrity

Cohere in action.

  • 8-9x

    return on investment

  • Up to 87%

    improvement in auditor efficiency

  • Up to 94%

    hit rate improvement

  • 1 in 3

    no-finding audits converted to findings through second-pass AI review

Two approaches to payment integrity

Traditional vendors
Detection logic
Full transparency into detection logic, so your team sees exactly why a claim was flagged.
High-level savings summaries with limited insight into why claims are flagged.
Rule changes
Non-technical teams build and iterate rules in hours.
IT hand-offs and vendor queues that can take weeks.
Rule maintenance
Rules are maintained automatically as codes, policies, and reference tables change.
Rules degrade as coding standards and policies evolve.
Pricing model
Flexible pricing aligned with long-term program health, not just recoveries.
Contingency fees that reward recovery over root-cause resolution.
Provider trust
Evidence-based findings letters with clear, root-cause explanations.
Findings with limited rationale, driving disputes and abrasion.
Operational control
Full operational control, with flexible engagement models including full end-to-end services, in-house automation, or hybrid support.
Vendor-managed workflows that limit in-house visibility.

Built for the teams accountable for the results

Operational control, on your terms

Insource complex reviews, augment your team with precision AI, or get full end-to-end services support through Cohere. You decide where vendor dependency ends.

Provider relationships that hold up

Transparent, evidence-based findings letters reduce disputes and give providers a clear path to correct upstream billing issues.

Return you can defend

Up to 8-9x ROI, backed by full visibility into how every finding and every dollar was calculated.

Read the case study

Testimonials

What health plans are saying

Great partner

Cohere has been a great partner in helping us gain better and earlier insight into the care our members are receiving while continuing to decrease administrative burden for our providers.

VP at Regional Health Plan

Improved clinical outcomes

This partnership enables faster, improved clinical outcomes for our members while reducing administrative burdens for our providers through enhanced workflows and automation.

Vice President of Clinical Population Health at a Regional Health Insurance Plan

Illustration of two large 3D arrows (orange and blue) circling around a pink heart shape, surrounded by three labeled callouts: "Precision AI," "Best-in-class PI solutions," and "In-house scalability."
Two large curved arrows, one yellow pointing downwards and one blue pointing upwards, with a pink heart shape between them; text boxes around highlight 'Led by world-class imaging specialists,' 'Transparent & compliant workflows,' and 'Non-denial-based approach.'Two large curved arrows, one yellow pointing downwards and one blue pointing upwards, with a pink heart shape between them; text boxes around highlight 'Led by world-class imaging specialists,' 'Transparent & compliant workflows,' and 'Non-denial-based approach.'

What are your **"no finding" claims** hiding?

See how intelligent claim selection and precision AI enhanced a health plan's existing PI program, uncovering more than $1M in inpatient DRG savings that had already moved through traditional review workflows.
Read the case study: How Precision AI Unlocked $1M+ in Inpatient DRG Savings
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